CME accreditation information

Increasing administrative responsibilities—due to regulatory pressures and evolving payment and care delivery models—reduce the amount of time physicians spend delivering direct patient care. Organizational development focuses on optimizing management, integration, improvement and adaptability to increase effectiveness and efficiency so that an organization—in this case, a medical practice—can achieve its goals. Optimizing the practice can improve patient experience and outcomes and create a more efficient and satisfying work environment.

Objectives

Track the progress of change initiatives using a project management approach

Establish systematic and sustainable changes

Target Audience

This activity is designed to meet the educational needs of practicing physicians.

Statement of Need

In today’s health care environment, medical practices may lack a professional approach in many critical organizational areas such as financial systems, staffing and clinical quality. In order to improve the effectiveness and efficiency of medical practices, while still delivering high-quality care to patients, practices must take a professional management approach. Organizational development focuses on optimizing management, integration, improvement and adaptability to increase effectiveness and efficiency so that an organization—in this case, a medical practice—can achieve its goals. The goal is to develop a culture of improvement that supports an iterative process in which everyone is able to identify better ways to get the practice’s important work done. Organizational development requires substantial time and effort, but the end result is a medical practice that is more service-oriented with improved patient experience, more effective with better patient outcomes, more efficient with an increased bottom line and more satisfying with a work environment that supports and encourages all involved.

Statement of Competency

This activity is designed to address the following ABMS/ACGME competencies: practice-based learning and improvement, interpersonal and communications skills, professionalism, systems-based practice and also address interdisciplinary teamwork and quality improvement.

Accreditation Statement

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The American Medical Association designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claiming Your CME Credit

To claim AMA PRA Category 1 Credit™, you must 1) view the module content in its entirety, 2) successfully complete the quiz answering 4 out of 5 questions correctly and 3) complete the evaluation.

About the Professional Satisfaction, Practice Sustainability Group

The AMA Professional Satisfaction and Practice Sustainability group has been tasked with developing and promoting innovative strategies that create sustainable practices. Leveraging findings from the 2013 AMA/RAND Health study, “Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy,” and other research sources, the group developed a series of practice transformation strategies. Each has the potential to reduce or eliminate inefficiency in broader office-based physician practices and improve health outcomes, increase operational productivity and reduce health care costs.

Disclosure Statement

The content of this activity does not relate to any product of a commercial interest as defined by the ACCME; therefore, neither the planners nor the faculty have relevant financial relationships to disclose.

Introduction

What is organizational development?

Organizational development centers on optimizing management, integration, improvement and adaptability to increase effectiveness and efficiency so that an organization—in this case, a medical practice—can achieve its goals. In other words, the practice must be organized in a way that enables practice transformation to occur. Although there is a wealth of literature on organizational development in other industries, applying these principles to improve the organization of a medical practice has only recently gained traction. Four key elements will optimize success in the organization of your practice: leadership, teamwork, communication and metrics.

Five steps to approach organizational development

Perform a practice assessment

Develop and share a vision for your practice

Designate and train your change team

Document your progress with a project management approach

Design systematic and sustainable changes

1

Perform a practice assessment

We can now get turn-by-turn driving directions for any trip on MapQuest or Google Maps using only two pieces of information:

Where are we now?

Where are we going?

Designing a road map for practice transformation is no different. Start your work with an objective and systematic look at the current status of the practice and how it is operating. Key areas to assess are:

Some practices lack a data-driven and professional approach to financial management, staffing and clinical quality. Even practices associated with or owned by larger organizations with central management structures often have similar issues at the “micro-system” level, where patient care actually takes place. If we are to improve the effectiveness and efficiency of our medical practices while delivering high-value care to our patients, we must move to a more professional management approach in these critical areas.

Feeling exhausted at the end of the day? Never really feeling like you are caught up? Perpetually late to dinner or family events? Doing more office work at night after the kids are in bed? An honest, introspective evaluation of how your practice is organized and functions is likely to yield many opportunities for improvement. In the end, we all want our practices to be more service-oriented with improved patient experience, higher quality outcomes, increased efficiency and additional support and encouragement to enhance the work environment.

2

Develop and share a vision for your practice

The second piece of information necessary to build your roadmap is projecting your practice’s future state by considering where you want to go. Key questions to ask are:

What are you really trying to accomplish?

What do you want to be known for?

What are your goals regarding patient care, efficient workflow, a team approach to care, practice vitality and a positive work environment?

What do you have to do to be successful as the payment system moves from rewarding volume to rewarding value?

It is often helpful to include physicians, staff members and patient advisors in creating this organizational vision. In Leading Change, John Kotter suggests forming a guiding coalition of a few forward-thinking, change-oriented and positive people within the organization. This coalition then crafts a shared vision that provides a clear picture for all about “where we are going.” Many practices and medical centers share their vision statements online, so everyone knows what is guiding everyone who works there.

Communicate the vision and engage others

Once you have clearly defined the vision for practice transformation, it is critical that everyone else in the organization understands the new direction and the desired future state. Practice leaders must clearly articulate the vision and discuss it often. A clear and compelling vision can be a real motivator for change, but it must be “front of mind” for all. Signs, posters or tag lines provide constant reminders that the practice is undergoing change together and moving towards providing more efficient and higher quality care for patients. Start or end team meetings and huddles with a reminder of the practice’s vision.

With a clear vision of your destination in mind and engagement from everyone in the practice, you can then establish very specific aims and goals with designated timelines.

The staff in each location should buy into that location’s vision and fit their culture. Sometimes, if a nurse or medical assistant (MA) floats to an office and reports to a divisional leader somewhere else, they may not completely participate in or engage with the transformative work that is happening at each place. In this scenario, it would be ideal for all staff to report through their local team, so they have more interest in the practice’s efforts and can actively participate and contribute to the transformation efforts of the team.

3

Designate and train your change team

One of the most important steps you can take in developing your practice or organization is to identify a small team to take on the responsibility of managing and monitoring change. Typically, the change team should be a group of three or four individuals with the interest and aptitude to lead the effort. In a single-physician office, it may be best to involve everyone. Make sure they have the time and resources available to do this important work while still meeting their patient-care responsibilities.

It is likely unnecessary to send everyone to Lean or Six-sigma Black Belt training, but some reading or online education about the basics of quality improvement and change management will speed up the effort and help the team avoid common mistakes (for more information, see the STEPS Forward™ Lean and change-management modules). In order to create an environment where meaningful change can occur, it is essential that everyone—both within the change team and in the practice as a whole—feels safe in suggesting improvement opportunities that can then be properly evaluated and tested before full implementation.

This meeting was the first time we were able to step away from the office chaos, look at how things could be improved and work together to solve our problems.

Members of a change team should be identified based on their roles and the nature of the change effort. A multidisciplinary change team may consist of physicians, nurses, MAs, administrative and registration representatives, information technology and/or compliance. At various points throughout the change process, the team may engage additional experts in Lean approaches, financial management, behavioral health and care management who can aid in executing the new model.

Having an organized and systematic plan for change will save a significant amount of time and effort. Just as you rely on your care team to help with patient care, you will need to entrust the majority of the office re-organization work to your change team. Physicians generally cannot devote large blocks of time to change initiatives. Rather, the physician can allocate resources and provide guidance while the office staff enacts the change.

4

Document your progress with a project management approach

If your practice has never used project management in implementing a project or initiative, you may not yet have an appreciation for what a huge help it can be in organizing the team and its work and tracking progress. You do not need to invest in expensive project management software to manage your organizational change initiatives. Even using a one-year wall calendar to document project milestones, responsibilities and resources can keep the initiative on track and ensure that the practice’s time and effort are not wasted. Simplistic approaches go a long way toward reaching goals on budget and on time! Tracking the progress of a complex project ensures that all of the project elements progress on time and in sync. The project manager can aid in resource allocation, foster accountability and help everyone appreciate the daily progress even when the final outcome may still be a distant vision.

Design systematic and sustainable changes

The natural human tendency when faced with a problem is to fix the immediate issue. Yet, one of the hallmarks of a great organization is that, when faced with a quality problem or a performance issue, it looks at systematic solutions that can be implemented over the long term to reduce errors and poor results. High-functioning organizations do not implement “band-aid” fixes. Furthermore, to be successful in a rapidly changing world, the organization must develop a “measure…improve…measure” mindset (e.g., Plan-Do-Study-Act practice improvement framework) to continuously identify needs, ways to address them, and evaluate their effectiveness. For lasting change, begin to think about systematic solutions such as:

Quality measures embedded in the electronic health record system to enable constant feedback regarding clinical performance

Conclusion

Improving organizational efficiency and effectiveness requires substantial time and effort, but the end result is worth it. The alternative is to continue on the same path, encountering the same frustrating issues day after day. The goal is to develop a culture of improvement that supports an iterative process where everyone is identifying better ways to get the practice’s important work done. The result will be a medical practice that is more service-oriented for patients, more effective for better patient outcomes and more efficient for a better bottom line, producing a more fun work environment for all involved.

Email the module "[Module Title]"

Obtaining CME credits with STEPS Forward™

AMA PRA Category 1 Credit™ will be available for the activity. Physicians should claim only the credit commensurate with the extent of their participation in the activity. In order to claim AMA PRA Category 1 Credit™, you must: 1) view the module in its entirety, 2) successfully complete the quiz by answering 4 out of 5 questions correctly and 3) complete the evaluation.

Already completed this module?

If you have already completed this module, you can claim AMA PRA Category 1 Credit™ or receive a certificate of participation through the AMA Education Center.